Long-Term Outcome of No-Touch Radiofrequency Ablation for Treating AFP-Positive Small Hepatocellular Carcinoma

Objective: This study aimed to evaluate the short- and long-term efficacy of no-touch radiofrequency ablation (NT-RFA) in treating patients with AFP-positive, solitary hepatocellular carcinoma (HCC) with a diameter of ≤ 3cm, and to assess its effect on AFP levels. Methods: A retrospective analysis was conducted on 245 AFP-positive HCC patients treated with NT-RFA (n=78) and Conventional RFA (C-RFA) (n=167) at our center between 2015 and 2023. The changes of AFP levels were compared. Statistical analysis was conducted on the overall survival(OS), recurrence free survival(RFS), and tumor recurrence status of the two groups at 1 to 5-years post-RFA. Results: The decrease in postoperative AFP levels was significantly greater in the NT-RFA group than that in the C-RFA group (P=0.009), and the postoperative AFP seronegative rate in the NT-RFA group was significantly higher than that in the C-RFA group (P=0.020). The OS rates at 1-, 3-, and 5-years were 100.00%, 71.07%, and 54.07% for NT-RFA group, while 95.21%, 62.06%, and 30.80% for C-RFA group. Significant differences existed between the two groups (P=0.026). The 1-, 3-, and 5-year RFS rates in the NT-RFA group were 79.49%, 46.36%, and 29.96%, while 65.87%, 30.99%, and 21.20% in the C-RFA group. Significant differences existed between the two groups (P=0.025). The 1-, 3-, and 5-year local tumor progression-free survival (LTP-FS) rates were 89.67%, 83.31%, 81.06% in the NT-RFA group and 79.01%, 64.61%, 63.10% in the C-RFA group. Significant differences existed between the two groups (P=0.002). But there was no significant difference in intrahepatic distant recurrence-free survival (IDR-FS) between the two groups (P=0.819). Conclusion: Compared with C-RFA, NT-RFA treatment for AFP positive HCC ≤ 3cm is more effective in reducing postoperative AFP levels and improving the rate of AFP conversion to negative. Meanwhile, NT-RFA significantly increased RFS and OS. It can replace C-RFA as the primary treatment method for AFP-positive small HCC.